C10023026 / invoice 10000

Reason:  Rash on ventrum and vomiting
History: O noticed that Leila had a lumpy rash after the groomers and vomited 5 times last night (mostly digested food and later bile) - O woke up to 5 small pools of vomit. O says she recovered quickly. Not aware of anything different used at groomers, not aware of eating anything unusual - not a known scavenger. 

Current medications: None

What Preventative health cover is being used and do you need to purchase any today?
Vaccination:
Worming: 
Flea control: 
Heartworm Prevention: 

Examine: 
Mentation: 
Body condition score: 
MM:                CRT: 
HR:                RR: 
LN: 
Temperature: 38.8

Ocular: 
Oral/Dental stage:
Ears: 
Cardiovascular: 
Respiratory: 
Gastrointestinal: 
Integumentary & lumps (measurement, location):
Musculoskeletal: 
Urogenital: 
Neurological: 

Problem List:
- Vomiting
- Rash on ventrum

Assessment: BAR, no rash observed on ventrum, no heat or inflammation - systemically well. Moist pink MMs, well hydrated. Soft palpable abdomen. No insect bites observed - possible anaphylaxis/reaction to something used at groomers. Normal temperature. 

Treatment: O to return if this happens again, nothing dispensed today as no evidence of rash 

Plan: Discussed returning if any sickness returns, also discussed possible allergic reaction/possible ingestion at groomers. O to speak to groomer to get more info on what may have been used. 

Reason:  Paw irritation
History: 
Male owner presented Leila for licking of paws. 
Owner reports this has been an ongoing issue for Leila. Has been trialled on cytopoint and apoquel. Owner reports this made no improvement. 
Skin lump removed end of December. No issues with this surgery. 
Owner reports currently applying malaseb and nutriderm for paws. History of interdigital cysts. 

Current medications: Amitriptyline 10mg PO SID - owner has stopped this as reports it makes no difference. Reports he used it for the full 4 weeks. Elocon being applied. Nutriderm. 
Examine: 
BAR pink moist mm 
CRT 1-2 sec 
Dental: Clean teeth 
Integument: Healthy coat. No interdigital erythema noted. Sutures intact on face. Owner has been advised these are dissolvable. 

Assessment: 
Obsessive licking of paws
ddx. atopy, behavioural > other 

Treatment: 
Owner was insistent that he had been advised that there was another medication he could try. Advised I am unsure of what this would be. 
Looking at history could not see that Leila had a prednsiolone trial. Advised this can have side effects and will require lower dosages if to be used long term. 

Plan: 
Start tapering dose of prednisolone and revisit in 2 weeks. 
RV in 2 weeks to discuss if any improvement. 

INTERPRETATION:
Nodular sebaceous hyperplasia
Histologic margins: Clear
COMMENTS:
Histopathology of Leila's skin mass revealed nodular sebaceous hyperplasia. This is a benign,
non-neoplastic, proliferative lesion in the skin of older dogs. Lesions may rise anywhere on the body,
but are most common on the dorsal head, ears, face and legs. Some dogs may show a tendency to develop
multiple lesions of this type. Poodles, Cocker Spaniels and some breeds of Terriers appear to be
predisposed although the lesion can be seen in all breeds of dogs. Severe secondary inflammatory
changes may occur if the lesions rupture or become infected. Complete excision is usually curative.


Called O with results. Very happy to hear nothing serious. S/O on 14/1, O has already booked in.